Liikunta kroonisten sairauksien hoidossa

Abstract

Vähäinen fyysinen aktiivisuus on useiden kroonisten sairauksien riskitekijä. Viime vuosikymmeninä on lisääntyvästi tutkittu liikuntahoitojen vaikuttavuutta sairauksien hoidossa. Satunnaistettuihin kontrolloituihin tutkimuksiin perustuvat meta-analyysit osoittavat että liikunta on positiivisesti vaikuttava osatekijä monien kroonisten sairauksien hoidossa. Meta-analyysitulosten mukaan liikuntahoitojen vaikutuksia ovat kroonisesti sairaiden potilaiden fyysisen kunnon paraneminen, kipujen väheneminen erityisesti useissa tuki- ja liikuntaelinsairauksissa, sairauksien etenemisen hidastuminen erityisesti kardiometabolisissa sairauksissa, masennuksen väheneminen, yleisen hyvinvoinnin paraneminen ja joissain sairauksissa eliniän piteneminen.

The number of meta-analyses based on randomized controlled trials evaluating the effects of physical exercise therapy as an important component in the treatment of specific diseases and related functional impairments has recently increased substantially. This paper briefly summarizes the evidence so far on the effects of exercise therapy in the treatment and rehabilitation of different chronic diseases. The most direct effect of exercise therapy or training is an increase in physical fitness and function, which has been shown to occur in most of the chronic diseases studied. Improvements have been recorded in muscular, aerobic and task-specific functions depending on the training programmes. As expected, changes of cardio-metabolic risk factor levels have been studied most in patients with cardio-vascular diseases and type 2 diabetes, where improvements in lipid risk factor levels have been documented. Exercise reduces glycosylated haemoglobin levels among patients with type 2 diabetes. Data on the positive effect of exercise on disease progression in hypertension, COPD, asthma and depression patients as well as on reduced re-infarction rates in myocardial infarction patients is also available. There are meta-analyses showing reduction of pain symptoms in mild to moderate osteoarthritis, chronic low-back pain and fibromyalgia. Finally, exercise therapy groups compared to control groups have been reported to have reduced disease specific mortality in coronary heart disease, myocardial infarction and heart failure patients. Since long-term adherence is a general problem in exercise therapy, supervised exercise programmes usually give better results than non-supervised programmes, although the cost-effectiveness of non-supervised programmes may be higher. A challenge for the future will be to improve the infrastructure to support safe exercising among patients with chronic disease.